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Epis F, Chatenoud L, Somaschini A, Bitetti I, Cantarero F, Salvati AC, Rocchi D, Lentini S, Giovanella E, Portella G, Langer M. Simple open-heart surgery protocol for sickle-cell disease patients: a retrospective cohort study comparing patients undergoing mitral valve surgery. Interact Cardiovasc Thorac Surg 2022; 35:6677232. [PMID: 36018254 PMCID: PMC9426665 DOI: 10.1093/icvts/ivac205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/22/2022] [Accepted: 08/25/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Sickle-cell disease (SCD) patients are considered to be at high risk from open-heart surgery. This study assessed the role of a simple sickling-prevention protocol. METHODS Perioperative non-specific and SCD-specific morbidity and 30-day mortality are investigated in a retrospective cohort study on patients undergoing isolated mitral valve surgery. Patients with and without SCD were compared. In the SCD cohort, a bundle of interventions was applied to limit the risk of sickling: 'on-demand' transfusions to keep haemoglobin levels of around 7-8 g/dl, cardiopulmonary bypass (CPB) with higher blood flow and perfusion temperature, close monitoring of acid-base balance and oxygenation. RESULTS Twenty patients with and 40 patients without SCD were included. At baseline, only preoperative haemoglobin levels differed between cohorts (8.1 vs 11.8 g/dl, P < 0.001). Solely SCD patients received preoperative transfusions (45.0%). Intraoperative transfusions were significantly larger in SCD patients during CPB (priming: 300 vs 200 ml; entire length: 600 vs 300 ml and 20 vs 10 ml/kg). SCD patients had higher perfusion temperatures during CPB (34.7 vs 33.0°C, P = 0.01) with consequently higher pharyngeal temperature, both during cooling (34.1 vs 32.3°C, P = 0.02) and rewarming (36.5 vs 36.2°C, P = 0.02). No mortality occurred, and non-SCD-specific complications were comparable between groups, but one SCD patient suffered from perioperative cerebrovascular accident with seizures, and another had evident haemolysis. CONCLUSIONS SCD patients may undergo open-heart surgery for mitral valve procedures with an acceptable risk profile. Simple but thoughtful perioperative management, embracing 'on-demand' transfusions and less-aggressive CPB cooling is feasible and probably efficacious.
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Affiliation(s)
- Francesco Epis
- Corresponding author. Anaesthesia and Intensive Care Unit II, Fondazione IRCCS Policlinico San Matteo, Via Indipendenza, 80, 27100 Pavia, Italy. Tel: +39-347-0676727; e-mail: (F. Epis)
| | - Liliane Chatenoud
- Department of Public Health, Laboratory of Clinical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Ilaria Bitetti
- Anaesthesia and Intensive Care Unit I, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Italy
| | | | | | - Daniela Rocchi
- EMERGENCY Ong Onlus, Milan, Italy,Salam Centre for Cardiac Surgery, EMERGENCY Ong Onlus, Khartoum, Sudan
| | - Salvatore Lentini
- EMERGENCY Ong Onlus, Milan, Italy,Salam Centre for Cardiac Surgery, EMERGENCY Ong Onlus, Khartoum, Sudan
| | - Elena Giovanella
- EMERGENCY Ong Onlus, Milan, Italy,Salam Centre for Cardiac Surgery, EMERGENCY Ong Onlus, Khartoum, Sudan
| | | | - Martin Langer
- EMERGENCY Ong Onlus, Milan, Italy,University of Milan, Milan, Italy
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2
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Taylor M, Mouyer Z, Callan P, Shaw S, Venkateswaran R, Nwaejike N. Axillary intra-aortic balloon pump, biventricular assist device implantation and subsequent orthotopic heart transplantation in a patient with sickle cell trait. J Surg Case Rep 2022; 2022:rjac260. [PMID: 35733976 PMCID: PMC9205687 DOI: 10.1093/jscr/rjac260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
A 38-year-old male with sickle cell trait and acute refractory heart failure received an axillary intra-aortic balloon pump and short-term biventricular assist device. He underwent orthotopic heart transplantation 45 days later, which was complicated by major bleeding necessitating significant intra-operative transfusion. Support with veno-arterial extracorporeal membrane oxygenation was provided and successfully weaned five days later. He made a full recovery and remains alive and well 34 months after discharge. We hypothesize that the protective peri-operative measures undertaken, including normothermia during surgery and post-operative haemodynamic stability due to the use of mechanical circulatory support, conveyed a degree of protection against complications associated with sickle cell dysfunction and contributed to the successful outcome.
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Affiliation(s)
- Marcus Taylor
- Department of Cardiothoracic Transplantation, Manchester University Hospital NHS Foundation Trust , Wythenshawe Hospital, Manchester, UK
| | - Zakariya Mouyer
- Department of Cardiothoracic Transplantation, Manchester University Hospital NHS Foundation Trust , Wythenshawe Hospital, Manchester, UK
| | - Paul Callan
- Department of Cardiothoracic Transplantation, Manchester University Hospital NHS Foundation Trust , Wythenshawe Hospital, Manchester, UK
| | - Steve Shaw
- Department of Cardiothoracic Transplantation, Manchester University Hospital NHS Foundation Trust , Wythenshawe Hospital, Manchester, UK
| | - Rajamiyer Venkateswaran
- Department of Cardiothoracic Transplantation, Manchester University Hospital NHS Foundation Trust , Wythenshawe Hospital, Manchester, UK
| | - Nnamdi Nwaejike
- Department of Cardiothoracic Transplantation, Manchester University Hospital NHS Foundation Trust , Wythenshawe Hospital, Manchester, UK
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3
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Bishnoi S, Yadav P, Shah P. Modifying priming techniques in cardiopulmonary bypass circuit in known case of sickle-cell trait undergoing open heart surgery. Perfusion 2022; 38:863-867. [PMID: 35491903 DOI: 10.1177/02676591221077819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Modifying cardiopulmonary bypass (CPB) circuit’s priming technique before the onset of CPB in cardiac patients known with sickle-cell disease or sickle cell trait has been observed to be of substantial significance in dealing with such challenges without having any life-threatening consequences. We modified our routine heparinized crystalloid priming of the CPB circuit with partial exchange transfusion by adding donor blood (packed red blood cells), fresh frozen plasma (FFP), and bicarbonate. This has helped us bring down the overall sickle cell hemoglobin in the blood thereby reducing its risk of sickling.
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Affiliation(s)
| | | | - Pratik Shah
- Department of Research, UNMICRC, Ahmedabad, India
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4
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Oyedeji CI. Optimizing management of sickle cell disease in patients undergoing surgery. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:405-410. [PMID: 34889383 PMCID: PMC8791118 DOI: 10.1182/hematology.2021000274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Individuals with sickle cell disease (SCD) are likely to be referred for surgery at some point in their lifetime due to a high incidence of musculoskeletal and intrabdominal complications such as avascular necrosis and gallbladder disease. Preoperative optimization is a multidisciplinary process that involves a hematologist with SCD expertise, an anesthesiologist, and the surgical team. The type and risk classification of the surgery, disease severity, medications, baseline hemoglobin, transfusion history, and history of prior surgical complications are often documented. Clinicians should consider perioperative risk assessment that includes determining the patient's functional status and cardiovascular risk and screening for obstructive sleep apnea. Many patients will require preoperative transfusion to reduce the risk of postoperative complications such as acute chest syndrome and vaso-occlusive pain crises. The hematologist should consider the patient's preoperative transfusion requirements and ensure that the surgical team has an appropriate plan for postoperative observation and management. This often includes follow-up laboratory studies, a postoperative pain management plan, and venous thromboembolism prophylaxis. The transfusion plan should be patient-specific and take into account the SCD genotype, baseline hemoglobin, disease severity, risk classification of the surgery, and history of prior surgical complications. In the intraoperative and postoperative period, dehydration, hypothermia, hypotension, hypoxia, and acidosis should be avoided, and incentive spirometry should be utilized to minimize complications such as acute chest syndrome. In this review we discuss preoperative, intraoperative, and postoperative strategies to optimize patients with SCD undergoing surgery.
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Affiliation(s)
- Charity I. Oyedeji
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC
- Correspondence Charity I. Oyedeji, Division of Hematology, Department of Medicine, Duke University School of Medicine, 315 Trent Dr, Hanes House, Ste 261, DUMC Box 3939, Durham, NC 27710; e-mail: char
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5
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Ravishankar R, Turkistani L, Elghoneimy Y, Manoly I. Aortic valve replacement in a patient with sickle cell disease-Are we justified to perform surgery in the TAVI era? Clin Case Rep 2021; 9:e04085. [PMID: 34471536 PMCID: PMC8387662 DOI: 10.1002/ccr3.4085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/24/2021] [Accepted: 03/05/2021] [Indexed: 11/06/2022] Open
Abstract
Not all variants of SCD need the same management and this should be decided on a case-by-case basis. Heterozygous SCD patients can undergo cardiac surgery without the need for intraoperative exchange transfusions with good clinical outcomes.
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Affiliation(s)
| | | | | | - Imthiaz Manoly
- Department of Cardiothoracic SurgeryJames Cook University HospitalMiddlebroughUK
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6
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Toyoda M, Kitamura T, Nakashima K, Matsunaga Y, Nie M, Miyaji K. Spontaneous splenic rupture, mesenteric ischemia and spinal infarction after aortic repair for acute type A dissection in a patient with sickle cell trait. Gen Thorac Cardiovasc Surg 2020; 69:560-563. [PMID: 33090364 PMCID: PMC7900333 DOI: 10.1007/s11748-020-01520-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/11/2020] [Indexed: 11/04/2022]
Abstract
Sickle cell trait (SCT), a benign hematological condition affecting approximately 300 million individuals globally, is associated with an increased risk of vaso-occlusive disease. However, the risks related to surgery employing cardiopulmonary bypass in patients with SCT are not well established. Herein, we report the case of a 27-year-old African American man with SCT who underwent an emergency aortic repair for acute Stanford type A aortic dissection using hypothermic circulatory arrest. The patient developed a sickle cell crisis, which was followed by spontaneous splenic infarction and rupture, nonocclusive mesenteric ischemia, and spinal infarction.
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Affiliation(s)
- Makoto Toyoda
- Department of Cardiovascular Surgery, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa, 243-0433, Japan.
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Minami-ku Kitasato 1-15-1, Sagamihara, Kanagawa, 252-0374, Japan
| | - Kouki Nakashima
- Department of Cardiovascular Surgery, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa, 243-0433, Japan
| | - Yoshikiyo Matsunaga
- Department of Cardiovascular Surgery, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa, 243-0433, Japan
| | - Masaki Nie
- Department of Cardiovascular Surgery, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa, 243-0433, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Minami-ku Kitasato 1-15-1, Sagamihara, Kanagawa, 252-0374, Japan
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Chacon-Portillo MA, Mossad EB, Zea-Vera R, Beckerman Z, Binsalamah ZM, Adachi I, Mery CM, Imamura M, Heinle JS, Fraser CD. Sickle Cell-Related Complications in Patients Undergoing Cardiopulmonary Bypass. World J Pediatr Congenit Heart Surg 2020; 11:565-571. [PMID: 32853076 DOI: 10.1177/2150135120926991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We aimed to describe our experience with patients with sickle cell trait (SCT) and undergoing surgery on cardiopulmonary bypass (CPB). METHODS Data on all patients with SCT or sickle-α thalassemia who underwent surgery on CPB were collected (1996-2017). RESULTS Overall, 46 patients were included, 37 (80%) had SCT and 9 (20%) had sickle-α thalassemia. A total of 4 (9%) developed a potential sickle cell-related complication. Patients with sickle cell-related complications were significantly older (median 14 years vs 14 months, P = .037) and heavier (median 54 kg vs 9 kg, P = .041). Complications occurred, although without statistical significance, in patients who underwent longer median CPB times (249 minutes vs 137 minutes, P = .069), lower median temperature (31.7 °C vs 33.3 °C, P = .094), and a higher percentage underwent deep hypothermic circulatory arrest (50% vs 7%, P = .053). A total of 30 (65%) patients underwent exchange transfusion (ET) pre-bypass. Patients who underwent ET were significantly older (median 4 years vs 7 months, P = .003) and heavier (median 16 kg vs 6 kg, P = .015) than patients who did not undergo ET. The incidence of complications was comparable between patients who underwent ET (10%) and those who did not (6%). CONCLUSIONS In this retrospective, single-center study, it has been shown that cardiac surgery requiring CPB in patients with SCT and sickle-α thalassemia had a low risk for sickle cell-associated complications. In this cohort of patients, older age, longer CPB times, lower median temperature, and the utilization of deep hypothermic circulatory arrest appear to play an important role in the development of complications.
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Affiliation(s)
- Martin A Chacon-Portillo
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Emad B Mossad
- Division of Pediatric Cardiovascular Anesthesia, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Rodrigo Zea-Vera
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Ziv Beckerman
- Texas Center for Pediatric and Congenital Heart Disease, 441903University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Ziyad M Binsalamah
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Iki Adachi
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, 441903University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, 441903University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
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8
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Chen T, Mordehai E, Sodha N, Kolodziejczak M, Savio C, Maslow A. Anesthetic Considerations for Percutaneous and Open Right Atrial Thrombectomy in a Hemoglobin SC Patient. J Cardiothorac Vasc Anesth 2020; 35:1161-1166. [PMID: 32807600 DOI: 10.1053/j.jvca.2020.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Tzonghuei Chen
- Department of Anesthesiology, Warren Alpert Medical School of Brown University, Providence, RI.
| | - Eveline Mordehai
- Department of Anesthesiology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Neel Sodha
- Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Christopher Savio
- Division of Cardiothoracic Surgery, Rhode Island Hospital, Providence, RI
| | - Andrew Maslow
- Department of Anesthesiology, Warren Alpert Medical School of Brown University, Providence, RI
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Levesque E, Lim C, Feray C, Salloum C, Quere A, Robin B, Merle J, Esposito F, Duvoux C, Cherqui D, Habibi A, Galacteros F, Bartolucci P, Azoulay D. Liver transplantation in patients with sickle cell disease: possible but challenging—a cohort study. Transpl Int 2020; 33:1220-1229. [DOI: 10.1111/tri.13669] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Eric Levesque
- Department of Anesthesia and Surgical Intensive Care‐Liver ICU AP‐HP Henri Mondor Hospital Créteil France
- Ecole Nationale Vétérinaire d’Alfort (ENVA) Faculté de Médecine de Créteil EA Dynamyc Université Paris‐Est Créteil (UPEC) Créteil France
| | - Chetana Lim
- Department of Hepatobiliary and Pancreatic Surgery and Transplantation Assistance Publique‐Hôpitaux de Paris Pitié‐Salpêtrière Hospital Paris France
| | - Cyrille Feray
- Centre Hepato‐Biliaire AP‐HP Paul Brousse Hospital Villejuif France
| | - Chady Salloum
- Centre Hepato‐Biliaire AP‐HP Paul Brousse Hospital Villejuif France
| | - Anne‐Laure Quere
- Department of Anesthesia and Surgical Intensive Care‐Liver ICU AP‐HP Henri Mondor Hospital Créteil France
| | - Benoit Robin
- Department of Anesthesia and Surgical Intensive Care‐Liver ICU AP‐HP Henri Mondor Hospital Créteil France
| | - Jean‐Claude Merle
- Department of Anesthesia and Surgical Intensive Care‐Liver ICU AP‐HP Henri Mondor Hospital Créteil France
| | | | | | - Daniel Cherqui
- Centre Hepato‐Biliaire AP‐HP Paul Brousse Hospital Villejuif France
| | - Anoosha Habibi
- Department of Internal Medicine Sickle Cell National Referral Center AP‐HP Henri Mondor Hospital‐UPEC Créteil France
| | - Frédéric Galacteros
- Department of Internal Medicine Sickle Cell National Referral Center AP‐HP Henri Mondor Hospital‐UPEC Créteil France
| | - Pablo Bartolucci
- Department of Internal Medicine Sickle Cell National Referral Center AP‐HP Henri Mondor Hospital‐UPEC Créteil France
| | - Daniel Azoulay
- Centre Hepato‐Biliaire AP‐HP Paul Brousse Hospital Villejuif France
- Department of Hepatobiliary and Pancreatic Surgery and Transplantation Sheba Medical Center Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Sousa ACCD, Campos FTAF, Bernardes RDC, Ivo MB, Corrêa RDA. Pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension and hemoglobinopathies. J Bras Pneumol 2020; 46:e20190287. [PMID: 32236344 PMCID: PMC7572282 DOI: 10.36416/1806-3756/e20190287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Frederico Thadeu Assis Figueiredo Campos
- . Hospital Madre Teresa, Belo Horizonte (MG) Brasil.,. Hospital Júlia Kubitschek, Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
| | | | | | - Ricardo de Amorim Corrêa
- . Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
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Schyrr F, Dolci M, Nydegger M, Canellini G, Andreu‐Ullrich H, Joseph J, Diezi M, Cachat F, Rizzi M, Renella R. Perioperative care of children with sickle cell disease: A systematic review and clinical recommendations. Am J Hematol 2020; 95:78-96. [PMID: 31456233 DOI: 10.1002/ajh.25626] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023]
Abstract
Children with sickle cell disease (SCD) require specific perioperative care, and clinical practice in this area remains poorly defined. We aimed to conduct a systematic, PRISMA-based review of the literature, available clinical guidelines and practice recommendations. We also aimed to extract any valuable information for the "best of available-evidence"-based prevention of perioperative adverse events in children with SCD, and highlight the most urgent priorities in clinical research. As data sources, US National Library of Medicine, Medline, National Guideline Clearinghouse, International Guideline Network, TRIP databases were searched for any content until January 2019. We also included institutional, consortia and expert group guidelines. Included were reports/guidelines in English, French, German, and Italian. Excluded were reports on obstetrical and fetal management. We identified 202 reports/guidelines fulfilling the criteria outlined above. A majority focused on visceral, cardiovascular and orthopedic surgery procedures, and only five were multicenter randomized controlled trials and two prospective randomized studies. After grading of the quality of the evidence, the extracted data was summarized into clinical recommendations for daily practice. Additionally, we designed a risk-grading algorithm to identify contexts likely to be associated with adverse outcomes. In conclusion, we provide a systematic PRISMA-based review of the existing literature and ancillary practice and delineate a set of clinical recommendations and priorities for research.
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Affiliation(s)
- Frederica Schyrr
- Pediatric Hematology‐Oncology Unit, Division of Pediatrics, Department “Woman‐Mother‐Child”Lausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Mirko Dolci
- Division of Anesthesia, Department of SurgeryLausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Martine Nydegger
- Division of Anesthesia, Department of SurgeryLausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Giorgia Canellini
- Transfusion Medicine Unit, Department of Laboratory MedicineLausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Heidrun Andreu‐Ullrich
- Transfusion Medicine Unit, Department of Laboratory MedicineLausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Jean‐Marc Joseph
- Division of Pediatric Surgery, Department “Woman‐Mother‐Child”Lausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Manuel Diezi
- Pediatric Hematology‐Oncology Unit, Division of Pediatrics, Department “Woman‐Mother‐Child”Lausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Francois Cachat
- Pediatric Nephrology Unit, Division of Pediatrics, Department “Woman‐Mother‐Child”Lausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Mattia Rizzi
- Pediatric Hematology‐Oncology Unit, Division of Pediatrics, Department “Woman‐Mother‐Child”Lausanne University Hospital and Lausanne University Lausanne Switzerland
| | - Raffaele Renella
- Pediatric Hematology‐Oncology Unit, Division of Pediatrics, Department “Woman‐Mother‐Child”Lausanne University Hospital and Lausanne University Lausanne Switzerland
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Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To determine the impact of sickle cell anemia on perioperative outcomes and resource utilization in elective spinal fusion surgery. SUMMARY OF BACKGROUND DATA Sickle cell anemia has been identified as an important surgical risk factor in otolaryngology, cardiothoracic surgery, general surgery, and total joint arthroplasty. However, the impact of sickle cell anemia on elective spine surgery is unknown. METHODS Hospitalizations for elective spinal fusion surgery between the years of 2001-2014 from the US National Inpatient Sample were identified using ICD-9-CM codes and patients were grouped into those with and without sickle cell anemia. The main outcome measures were in-hospital neurological, respiratory, cardiac, gastrointestinal, renal and urinary, pulmonary embolism, and wound-related complications and mortality. Length of stay and inpatient costs were also collected. Multivariable logistic regressions were conducted to compare the in-hospital outcomes of patients undergoing elective spinal fusion with or without sickle cell anemia. RESULTS From a total of 4,542,719 patients undergoing elective spinal fusions from 2001 to 2014, 456 sickle cell disease patients were identified. Sickle cell anemia is a significant independent predictor for pulmonary embolism [odds ratio (OR)=7.37; confidence interval (CI), 4.27-12.71; P<0.001], respiratory complications (OR=2.36; CI, 1.63-3.42; P<0.001), wound complications (OR=3.84; CI, 2.72-5.44; P<0.001), and overall inpatient complications (OR=2.58; CI, 2.05-3.25; P<0.001). Sickle cell anemia patients also have significantly longer length of stay (7.0 vs. 3.8 d; P<0.001) and higher inpatient costs ($20,794 vs. $17,608 P<0.05). CONCLUSIONS Sickle cell anemia is associated with increased risk of perioperative complications and greater health care resource utilization. Sickle cell anemia patients undergoing spinal fusion surgeries should be counseled on these increased risks. Moreover, current strategies for perioperative management of sickle cell anemia patients undergoing spinal fusion surgery need to be improved.
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Gozdzik M, Mariotti S, Genoni M, Zientara A. Perioperative Endocarditis Management in a Patient with Homozygous Sickle Cell Disease. Thorac Cardiovasc Surg Rep 2019; 8:e1-e4. [PMID: 30648104 PMCID: PMC6327749 DOI: 10.1055/s-0038-1676962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/16/2018] [Indexed: 11/29/2022] Open
Abstract
Background
Homozygous sickle cell disease (SCD) compounded with bacterial endocarditis makes open-heart surgery a multidisciplinary challenge.
Case description
A 45-year-old African male patient with homozygous SCD presented with right heart decompensation, tricuspid regurgitation, and endocarditis of the aortic valve. Blood coulters were positive for coagulase-negative staphylococci. An emergent double valve replacement was successfully performed involving a multidisciplinary team.
Conclusion
Homozygous SCD is associated with an increased risk of preoperative vaso-occlusive complications. Surgery with cardiopulmonary bypass can be performed, if hypothermia, hypoxia, acidosis, or low-flows are being avoided. Due to the lack of data, the adequate approach is still intuitive and requires standardization.
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Affiliation(s)
| | - Sergio Mariotti
- Department of Anesthesiology, Stadtspital Triemli, Zurich, Switzerland
| | - Michele Genoni
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alicja Zientara
- Department of Cardiac Surgery, Triemli Hospital, Zurich, Switzerland
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14
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Smith MM, Renew JR, Nelson JA, Barbara DW. Red Blood Cell Disorders: Perioperative Considerations for Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2018; 33:1393-1406. [PMID: 30201404 DOI: 10.1053/j.jvca.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Indexed: 02/03/2023]
Abstract
Disorders affecting red blood cells (RBCs) are uncommon yet have many important physiologic considerations for patients undergoing cardiac surgery. RBC disorders can be categorized by those that are congenital or acquired, and further by disorders affecting the RBC membrane, hemoglobin, intracellular enzymes, or excessive RBC production. A foundational understanding of the physiologic derangement for these disorders is critical when considering perioperative implications and optimization, strategies for cardiopulmonary bypass, and the rapid recognition and treatment if complications occur. This review systematically outlines the RBC disorders of frequency and relevance with an emphasis on how the disorder affects normal physiologic processes, a review of the literature related to the disorder, and the implications and recommendations for patients undergoing cardiac surgery.
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Affiliation(s)
- Mark M Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
| | - J Ross Renew
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | - James A Nelson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - David W Barbara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
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